Healthcare Provider Details

I. General information

NPI: 1982192597
Provider Name (Legal Business Name): GREATER BOSTON ABA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HMS STAYNER DR
HINGHAM MA
02043-1664
US

IV. Provider business mailing address

105 HMS STAYNER DR
HINGHAM MA
02043-1664
US

V. Phone/Fax

Practice location:
  • Phone: 617-957-6451
  • Fax: 781-385-7324
Mailing address:
  • Phone: 617-957-6451
  • Fax: 781-385-7324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY CESARIO
Title or Position: OWNER
Credential:
Phone: 617-957-6451